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1. Artificial corneas versus donor corneas for repeat corneal transplants. (Abstract)

Artificial corneas versus donor corneas for repeat corneal transplants. Individuals who have failed one or more full thickness penetrating keratoplasties may be offered repeat corneal surgery using an artificial or donor cornea. An artificial or prosthetic cornea is known as a keratoprosthesis. Both donor and artificial corneal transplantations involve removal of the diseased and opaque recipient cornea (or the previously failed cornea) and replacement with another donor or prosthetic cornea.To (...) assess the effectiveness of artificial versus donor corneas in individuals who have had one or more failed donor corneal transplantations.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 11); Ovid MEDLINE; Ovid Embase; LILACS (Latin American and Caribbean Health Sciences Literature database); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform

2020 Cochrane

2. Ex vivo expanded autologous human corneal epithelial cells containing stem cells (Holoclar) - For the treatment of adult patients with moderate to severe limbal stem cell deficiency (defined by the presence of superficial corneal neovascularisation in at

to chemical and physical burns. Limbal stem cells are important for corneal epithelial regeneration and wound healing. Deficiency can cause the conjunctiva to overgrow the cornea, leading to neovascularisation and development of an unstable corneal epithelium. This may progress to include ingrown fibrous tissue, corneal opacification, conjunctival scarring and ulceration. In addition to corneal neovascularisation, symptoms of LSCD can include pain, inflammation, photophobia and eventually, reduction (...) clinically relevant threshold of 50%. 2 ? The EMA considered that it was important to differentiate between patients with and without stromal scarring. In those with stromal scarring, limbal stem cell transplant has to be combined with subsequent keratoplasty to improve vision. A successful limbal stem cell transplant may facilitate a subsequent cornea transplant and reduce corneal graft rejection. Within the 57 patients who had keratoplasties after Holoclar ? 42% (24/57) had a successful outcome

2020 Scottish Medicines Consortium

3. Corneal superficial injury: What are the clinical features of corneal superficial injury?

include: A visible foreign body on the ocular surface. Linear scratches on the cornea. Subtarsal foreign bodies typically produce vertical tracks due to repeated scratching with blinking. Rust rings from a metallic foreign body. Basis for recommendation The information on the clinical features of superficial corneal injury is based on the clinical guidelines Corneal abrasion [ ], Corneal (or other superficial ocular) foreign body [ ] and Sub-tarsal foreign body [ ] and expert opinion in review (...) Corneal superficial injury: What are the clinical features of corneal superficial injury? Clinical features | Diagnosis | Corneal superficial injury | CKS | NICE Search CKS… Menu Clinical features Corneal superficial injury: What are the clinical features of corneal superficial injury? Last revised in June 2017 What are the clinical features of corneal superficial injury? Superficial corneal injury is typically unilateral and clinical features include : Sudden onset of eye pain on blinking

2018 NICE Clinical Knowledge Summaries

4. Corneal superficial injury: Scenario: Management of corneal superficial injury

Corneal superficial injury: Scenario: Management of corneal superficial injury Scenario: Management | Management | Corneal superficial injury | CKS | NICE Search CKS… Menu Scenario: Management Corneal superficial injury: Scenario: Management of corneal superficial injury Last revised in June 2017 Scenario: Management of corneal superficial injury From age 1 month onwards. When should I refer to an ophthalmologist? Refer the person immediately to the emergency eye service if: A suspected (...) is present. Foreign bodies composed of organic material (such as seeds, soil, insect scales or caterpillar setae) should be referred to ophthalmology as these are associated with a higher risk of infection and complications. Foreign bodies in or near the centre of the cornea are associated with an increased risk of permanent visual loss. Any of the following red flag clinical features are present: Severe pain. Irregular, dilated or non-reactive pupils. Significant reduction in visual acuity. Hyphaema

2018 NICE Clinical Knowledge Summaries

5. Corneal superficial injury: How should I assess a person with suspected superficial corneal injury?

, nonreactive or irregular or the iris is protruding. Assess visual acuity with a Snellen chart. Systematically examine the eye including: The conjunctiva — look for hyperaemia and foreign bodies. If a penetrating injury has been excluded the upper eyelids can be everted to check for foreign bodies. The cornea — look for foreign bodies, and clouding, opacity or infiltrates which may indicate chemical injury, corneal ulcer or infection. Suspected chemical injuries require prior to emergency assessment (...) by ophthalmology. If there is no indication for , fluorescein and the cobalt blue filter on an ophthalmoscope or Wood’s lamp can be used to identify corneal epithelial defects — defects will fluoresce bright green. If fluorescein staining appears to stream or change colour, as this is indicative of a penetrating globe injury. Traumatic corneal abrasions usually appear as linear or geographic shapes. A foreign body under the upper lid may produce multiple vertical lines on the superior cornea. Injury from

2018 NICE Clinical Knowledge Summaries

6. Artificial corneas versus donor corneas for repeat corneal transplants. Full Text available with Trip Pro

Artificial corneas versus donor corneas for repeat corneal transplants. Individuals who have failed one or more full thickness penetrating keratoplasties (PKs) may be offered repeat corneal surgery using an artificial or donor cornea. An artificial or prosthetic cornea is known as a keratoprosthesis. Both donor and artificial corneal transplantations involve removal of the diseased and opaque recipient cornea (or the previously failed cornea) and replacement with another donor or prosthetic (...) cornea.To assess the effectiveness of artificial versus donor corneas in individuals who have had one or more failed donor corneal transplantations.We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2013), EMBASE (January 1980 to November 2013), Latin American and Caribbean Health Sciences Literature Database (LILACS

2014 Cochrane

7. Ex vivo excimer laser ablation of cornea guttata and ROCK inhibitor-aided endothelial recolonization of ablated central cornea. Full Text available with Trip Pro

Ex vivo excimer laser ablation of cornea guttata and ROCK inhibitor-aided endothelial recolonization of ablated central cornea. To determine whether excimer laser ablation of guttae is a viable strategy for removal of diseased tissue in Fuchs' endothelial corneal dystrophy (FECD) on excised human Descemet membranes and whether an excimer laser-created wound on healthy human corneas ex vivo is recolonized with corneal endothelial cells.Descemet membranes of FECD patients and corneal endothelium (...) of normal human corneas were ablated ex vivo using an excimer laser licensed for glaucoma surgery. Specimens were kept in cell culture medium supplemented with 10 μm of rho-kinase inhibitor ripasudil. Corneal endothelial cell regeneration was observed using light and electron scanning microscopy. Furthermore, the whole corneal samples were evaluated by haematoxylin/eosin staining and immunohistochemical analysis using antibodies against Na+ /K+ -ATPase.Guttae and corneal endothelium could be ablated

2020 Acta ophthalmologica

8. Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study. Full Text available with Trip Pro

Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study. To report the corneal stroma cell density evolution identified by in vivo corneal confocal microscopy in humans using injected autologous adipose-derived adult stem cells (ADASCs) and corneal decellularized laminas in corneas with advanced keratoconus.Interventional prospective, consecutive, randomized, comparative (...) series of cases. A total of 14 keratoconic patients were randomly distributed into three groups for three types of surgical interventions: group 1 (G-1), autologous ADASC implantation (n = 5); group 2 (G-2), decellularized human corneal stroma (n = 5); and group 3 (G-3), autologous ADASCs + decellularized human corneal stroma (n = 4).A gradual and significant increase (P < 0.001) was observed in the cellularity in the anterior and posterior stroma of patients in G-1, G-2, and G-3 a year after

2020 Investigative Ophthalmology & Visual Science

9. Implantation of a corneal graft-keratoprosthesis for severe corneal opacity in wet blinking eyes

in specialist centres by surgeons experienced in the technique; long-term follow-up should be carried out by an experienced multidisciplinary team. 2 2 Indications and current treatments Indications and current treatments 2.1 Injury or disease of the cornea can make it opaque, stopping light from entering the eye and resulting in loss of vision. Some severe corneal diseases can also affect the eye's blink and tear mechanisms. Corneal injuries can be caused by direct trauma, including surgery, as well (...) as chemical or thermal burns. Diseases that can cause corneal opacity include autoimmune diseases, bullous keratopathy, keratoconus, keratitis and corneal stromal dystrophies. 2.2 The standard treatment for significant corneal opacity is a corneal transplant (penetrating keratoplasty). Penetrating keratoplasty removes the opaque cornea using a trephine, replacing it with a donor cornea. Some patients cannot have a standard corneal transplant for reasons including: disease severity; severe involvement

2015 National Institute for Health and Clinical Excellence - Interventional Procedures

10. Corneal collagen cross-linking for bacterial infectious keratitis. (Abstract)

Corneal collagen cross-linking for bacterial infectious keratitis. Infectious keratitis is an infection of the cornea that can be caused by bacteria, viruses, fungi, protozoa, or parasites. It may be associated with ocular surgery, trauma, contact lens wear, or conditions that cause deficiency or loss of corneal sensation, or suppression of the immune system, such as diabetes, chronic use of topical steroids, or immunomodulatory therapies. Photoactivated chromophore for collagen cross-linking (...) (PACK-CXL) of the cornea is a therapy that has been successful in treating eye conditions such as keratoconus and corneal ectasia. More recently, PACK-CXL has been explored as a treatment option for infectious keratitis.To determine the comparative effectiveness and safety of PACK-CXL with standard therapy versus standard therapy alone for the treatment of bacterial keratitis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials

2020 Cochrane

11. Exploration of alternative test methods to evaluate phototoxicity of ophthalmic agents by using Statens Seruminstitut Rabbit Cornea cell lines and 3D human reconstituted cornea models. Full Text available with Trip Pro

exposure to ultra violet (UV). However, as phototoxicity may occur in ocular cells, it is necessary to develop a more suitable test for cornea-derived cells. In this study, we attempted to establish a new in vitro PT method in rabbit corneal cell lines (SIRC). We evaluated five ophthalmic agents, ciprofloxacin, levofloxacin, lomefloxacin, norfloxacin, and tetracycline, for their cytotoxic potential and in vitro phototoxicity. The results obtained using 3D human corneal models revealed that the UV (...) Exploration of alternative test methods to evaluate phototoxicity of ophthalmic agents by using Statens Seruminstitut Rabbit Cornea cell lines and 3D human reconstituted cornea models. Many chemicals have been reported to induce phototoxicity. The absorbance of light energy within the sunlight range is a common characteristic of phototoxicity. The 3T3 NRU phototoxicity test (PT) in 3T3 mouse skin fibroblasts has been used to identify the phototoxic potential induced by excited chemicals after

2018 PLoS ONE

12. Accelerated contact lens-assisted corneal crosslinking and piggyback modification in a pediatric case with advanced keratoconus and thin cornea. (Abstract)

Accelerated contact lens-assisted corneal crosslinking and piggyback modification in a pediatric case with advanced keratoconus and thin cornea. A 14-year-old girl presented with bilateral keratoconus (KC). Maximum keratometry (Kmax) was 63.9 diopter (D) in the right eye and 63.7 D in the left eye. Minimum corneal thickness was 371 μm in the right eye and 370 μm in the left. The right eye underwent epithelium-off accelerated corneal crosslinking (CXL) using hypo-tonic dextran-free 0.1 (...) and effective treatment in this pediatric KC case with thin cornea.

2020 Journal of cataract and refractive surgery

13. Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea. Full Text available with Trip Pro

Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea. To compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL).This study evaluated thirty-one eyes of 31 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV (...) ), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey).All keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 6 months postoperatively at each point (Wilcoxon signed-rank test, superior, p = 0.16, nasal superior, p = 0.12, temporal superior, p = 0.17, inferior, p = 0.37, nasal inferior, p = 0.28, temporal inferior, p = 0.17

2020 BMC Ophthalmology

14. Correction to: Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology. Full Text available with Trip Pro

Correction to: Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology. An amendment to this paper has been published and can be accessed via the original article.

2020 BMC Ophthalmology

15. Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology. Full Text available with Trip Pro

Thickness profiles of the corneal epithelium along the steep and flat meridians of astigmatic corneas after orthokeratology. The aim of this study was to investigate the changes in corneal epithelial thickness along the principle meridians of astigmatic corneas after six months of overnight spherical myopic orthokeratology (OK) lens wear.This is a prospective study. Fifty-seven subjects with up to 1.50 diopters (D) of corneal toricity wore spherical OK lenses for 6 months. Evaluations of OK (...) lens fit, visual acuity, refractions and corneal toricity (CT) were performed. Fourier-domain optical coherence tomography (FD-OCT) was conducted to measure the corneal epithelial thickness (ET) along the principle meridians of corneal toricity over a diameter of 6 mm. The means of △ET of the same diameter at individual meridians (△ETSm and △ETFm) were calculated and compared.Visual acuity and refraction improved significantly after OK lens wear. △ETFm thinned more than △ETSm (P = 0.027) at 1.5 mm

2020 BMC Ophthalmology

16. University students' knowledge of corneal donation and willingness to donate corneas in the occupied Palestinian territory: a cross-sectional study. Full Text available with Trip Pro

University students' knowledge of corneal donation and willingness to donate corneas in the occupied Palestinian territory: a cross-sectional study. Access to corneal transplantation is limited worldwide because of poor knowledge. Ethical, religious, and cultural barriers contribute to low rates of corneal donation. In the occupied Palestinian territory, limited information is available on factors affecting corneal donation. The aim of this study was to assess the knowledge and willingness (...) %) respondents were aware of a lack in corneal donation, but 274 (64%; p=0·01) of these respondents did not show willingness towards corneal donation. 429 (68%) respondents were not willing to donate their corneas, the most common reasons being disapproval by family members and poor awareness. We found no association between sociodemographic factors and willingness was determined.Palestinian students are aware of the lack of local cornea donation but are unwilling to donate their corneas. The study results

2018 Lancet

17. ORA G3 to measure corneal hysteresis

by a healthcare professional through an in-built operator display. The patient positions their head in a headrest, which is adjusted to allow for measurements of the left or right eye. The device blows a short puff of air to slightly flatten the cornea, which then returns to its original shape. During this the device takes 2 measurements: the force needed to flatten the cornea and the force needed for it to reshape. The difference between the 2 measurements is defined as the level of corneal hysteresis (...) ORA G3 to measure corneal hysteresis ORA G3 to measure corneal h ORA G3 to measure corneal hysteresis ysteresis Medtech innovation briefing Published: 18 June 2018 nice.org.uk/guidance/mib150 pathways Summary Summary The technology technology described in this briefing is Ocular Response Analyzer (ORA) G3. It can be used to measure corneal hysteresis, a possible risk factor for glaucoma. The inno innovativ vative aspects e aspects are that ORA G3 is currently the only device capable

2018 National Institute for Health and Clinical Excellence - Advice

18. Repeatability of Cornea and Sublayer Thickness Measurements Using Optical Coherence Tomography in Corneas of Anomalous Refractive Status. (Abstract)

Repeatability of Cornea and Sublayer Thickness Measurements Using Optical Coherence Tomography in Corneas of Anomalous Refractive Status. To assess the repeatability of epithelial, stromal, and total corneal thickness measurements with spectral-domain optical coherence tomography (SD-OCT; RTVue-XR; Optovue, Inc., Fremont, CA) in patients with myopia, keratoconus, and corneas after transepithelial photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and femtosecond (...) laser-assisted in situ keratomileusis (FS-LASIK).A total of 352 eyes of 352 patients (75 myopic, 68 post-transepithelial PRK, 61 post-SMILE, 75 post-FS-LASIK, 20 mild keratoconus, and 53 advanced keratoconus eyes) were included. The epithelial, stromal, and total corneal thickness were recorded from the pachymetric map in the following four zones: (1) central 2-mm region, (2) eight paracentral regions within 2- to 5-mm diameter, (3) eight midperipheral regions within 5- to 7-mm diameter, and (4

2019 Journal of Refractive Surgery

19. [Corneal collagen cross-linking and intrastromal corneal ring segments in the treatment of corneal ectasia]

: Haute Autorité de Santé (HAS). 2015 Authors' conclusions These two procedures are presented as an alternative to corneal transplant. The expected effects are stabilisation of the disease from corneal collagen cross-linking (CXL), and visual rehabilitation from placement of intrastromal corneal ring segments (ICRS). Final publication URL INAHTA brief and checklist INAHTA brief and checklist Indexing Status Subject indexing assigned by CRD MeSH Collagen; Cornea; Corneal Diseases; Dilatation (...) [Corneal collagen cross-linking and intrastromal corneal ring segments in the treatment of corneal ectasia] Crosslinking du collagène cornéen et anneaux intra-cornéens dans le traitement des ectasies cornéennes [Corneal collagen cross-linking and intrastromal corneal ring segments in the treatment of corneal ectasia] Crosslinking du collagène cornéen et anneaux intra-cornéens dans le traitement des ectasies cornéennes [Corneal collagen cross-linking and intrastromal corneal ring segments

2015 Health Technology Assessment (HTA) Database.

20. Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification. (Abstract)

Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification. Cataract is the leading cause of blindness in the world, and clinically significant astigmatism may affect up to approximately 20% of people undergoing cataract surgery. Pre-existing astigmatism in people undergoing cataract surgery may be treated, among other techniques, by placing corneal incisions near the limbus (limbal relaxing incisions or LRIs) or by toric intraocular lens (IOLs (...) ) specially designed to reduce or treat the effect of corneal astigmatism on unaided visual acuity.To assess the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery.We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 9); Ovid MEDLINE; Ovid Embase and four other databases. The date of the search was 27 September 2019.We included randomised controlled trials (RCTs) comparing toric IOLs with LRIs

2019 Cochrane

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